| NPI | 1497260608 |
|---|---|
| Doing Business As | PROVIDENCE ASSISTED LIVING |
| Entity Type | Organization |
| Authorized Contact | TERMAINE MOORE Executive Director 919-247-4760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2017-12-11 |